Discontinuation of Anticoagulation With Intensive Rhythm Monitoring in Post-ablation Patients With Atrial Fibrillation

Prior treatment

• Prior left atrial appendage (LAA) occlusion, surgical LAA excision/closure, or intraoperative confirmation of LAA electrical isolation.

Other illness

• Moderate-to-severe mitral stenosis (mitral valve area ≤2.0 cm²) or mechanical heart valve.
• Any condition requiring continued oral anticoagulation (e.g., pulmonary embolism, deep vein thrombosis, hypertrophic cardiomyopathy, cardiac amyloidosis).
• Conditions associated with high non-cardioembolic stroke risk, including carotid, vertebral, or intracranial arterial stenosis ≥70%.
• Any condition that, in the investigator's judgment, would make the participant unsuitable for the study.

Lab values

• Increased bleeding risk, including any of the following:
  • Current ISTH major bleeding or clinically relevant non-major bleeding (CRNMB).
  • History of non-traumatic major bleeding (e.g., intracranial, intraocular, spinal, retroperitoneal, gastrointestinal, or intra-articular) unless the reversible cause has been permanently eliminated.
  • Unresolved intracranial aneurysm/vascular malformation, or active/unhealed gastric or duodenal ulcer.
  • General anesthesia surgery within the past 3 months.
  • Planned surgery within the next 3 months.
  • Known bleeding diathesis (e.g., hemophilia).
  • Uncontrolled hypertension (SBP \>180 mmHg and/or DBP \>110 mmHg).
  • Hemoglobin \<90 g/L or blood transfusion within 4 weeks prior to enrollment.
  • Platelet count \<50 × 10⁹/L.
  • End-stage kidney disease (eGFR \<15 mL/min/1.73 m²) or on dialysis.
  • Severe liver disease (e.g., esophageal variceal bleeding, ascites, hepatic encephalopathy, or jaundice).
  • Known intolerance to oral anticoagulants or contraindication to oral anticoagulation.

Age

• Life expectancy \<2 years.

Other

• Participants will be excluded if any of the following criteria are present:
• High risk of post-ablation recurrence (e.g. including premature atrial contraction burden \>3% on any ambulatory ECG/Holter recording).
• Female participants who are pregnant or breastfeeding, or of childbearing potential not using effective contraception.
• Current participation in another interventional clinical trial.

• Participants must meet all of the following criteria:
• Age 18 to 80 years.
• 60±15 to 365±15 days after atrial fibrillation/atrial flutter (AF/AFL) ablation.
• CHA2DS2-VA score ≥2.
• No history of stroke, transient ischemic attack (TIA), or systemic embolism.
• Continuous use of a NOAC since AF/AFL ablation.
• No documented atrial tachyarrhythmia recurrence since ablation.
• No antiarrhythmic drug (AAD) use within the past 2 months.
• Able and willing to provide written informed consent.
• Able and willing to comply with study procedures and follow-up.